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General NPI Number Information
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NPI Number | 1356086359
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE CONWAY
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Gender | Female
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 480 DD RD
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City | COLUMBIA
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State | IL
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Zip | 62236-3837
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Country | US
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Telephone | 618-215-6174
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Fax |
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Provider Business Mailing Address
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Address Line | 625 HARTMAN LN
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City | WATERLOO
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State | IL
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Zip | 62298-1861
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Country | US
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Telephone | 270-994-5979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056012922
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License Number State | IL
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